NEPHROTOXICANT TABLE
TOXIN SOURCE vetgirlontherun.com
MECHANISM OF ACTION
CLINICAL SIGNS
CLIN PATH FINDINGS
TOX TEST
TREATMENT
PROGNOSIS
NSAIDs Cats and certain dog breeds (e.g. German Shepherds anecdotally) are more sensitive and need to be treated aggressively. With cats, severe AKI is more commonly seen clinically and with dogs, GI signs secondary to GI ulceration (vomiting, diarrhea, melena, hematemesis, etc.) is more commonly seen initially, followed by secondary AKI.
N/A
DOG DOSES: 16-50 mg/kg – GI signs 50-100 mg/kg – severe GI signs 100-250 mg/kg - GI and renal >300 mg/kg – fatalities >400 mg/kg – CNS signs (coma, ataxia, seizures) CATS DOSES: >5 mg/kg – GI signs >20 mg/kg - renal >200 mg/kg – CNS signs DOG DOSES: Any dose – vomiting >20 mg/kg – GI signs >40 mg/kg – renal CATS DOSES: >4.4 mg/kg DOG DOSES: >15 mg/kg – GI issues >30 mg/kg – potential renal
Anorexia, vomiting, hematemesis, diarrhea, melena, abdominal pain, lethargy, malaise, uremic halitosis, GI ulceration dehydration, renal e ff ects, CNS e ff ects
Ibuprofen (Advil®, Bufren®, certain types of Motrin®)
• GI decontamination • Activated charcoal – multiple doses • IV fluid therapy for diuresis • GI protectants 7-10 days Chemistry – Baseline, then as needed up to 48 hours
Anemia Azotemia Liver changes
Competitive inhibition of prostaglandin (PG) synthesis –> mostly GI and AKI
possible based on dose and type of NSAID
Carprofen (Rimadyl®)
• GI decontamination • Activated charcoal – multiple doses • IV fluid therapy for diuresis • GI protectants 7-10 days Chemistry – Baseline, then as needed up to 48 hours • Emesis and activated charcoal X 1 (binds well to charcoal) • IV fluid therapy for diuresis • GI protectants 7-10 days Chemistry – Baseline, then as needed up to 48 hours Decontaminate: • activated charcoal – multiple doses T ½ (dog) is 74 hours, as the drug undergoes extensive enterohepatic recirculation Due to the prolonged half life, fluids need to be continued for at least 72 hours GI protectants for 7-14 days Recommend monitoring electrolytes, especially sodium Tablets rapidly dissolve, emesis may not be helpful unless ingestion was very recent • Single dose of activated charcoal • IV fluid therapy for diuresis • GI protectants 7-10 days Chemistry – Baseline, then as needed up to 48 hours
Competitive inhibition of PG synthesis –> mostly GI and renal e ff ects, reported liver e ff ects as well
Deracoxib (Deramaxx®)
Competitive inhibition of PG synthesis –> mostly GI and renal e ff ects
DOG DOSES: >25 mg/kg – vomiting, GI ulcers >50 mg/kg – renal
Firocoxib (Previcox®)
Competitive inhibition of PG synthesis –> mostly GI and renal e ff ects
DOG DOSES: >5 mg/kg/day for 7 days – ulcerative gastritis >10 – 25 mg/kg - renal
Naproxen sodium (Aleve®, certain types of Motrin®,
Competitive inhibition of PG synthesis –> mostly GI and renal e ff ects
Buproxen®, Naprofex®)
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